As we await the Supreme Court’s imminent decision on the constitutionality of the Affordable Care Act, here is a brief overview outlining the fundamentals of the case:
There are two groups of plaintiffs in the case: 1) 26 states, led by Florida; and 2) the National Federation of Independent Business and individuals plaintiffs. The defendant in the case is the US Department of Health and Human Services, Treasury, and Labor. It should be noted that the progression of this case, from commencing the suit in March 2010 to issuing a decision (presumably) in June 2012 has been extremely fast.
There are four main issues of the case that the Supreme Court will ultimately decide:
1.) Do courts have jurisdiction to decide the constitutionality of the ACA’s individual mandate provision right now?
2.) If so, is the ACA’s individual mandate provision constitutional?
3.) If unconstitutional, is the individual mandate provision severable, which means will other parts of the law be able to survive without it?
4.) Is the ACA’s Medicaid expansion constitutional? No matter what the court decides about the individual mandate, it’s expected that we will receive a definitive ruling on this.
For the first issue, HHS is arguing that the court does not have jurisdiction to hear the case yet because of the Anti-Injunction Act (AIA), which means that you cannot challenge a tax until it’s assessed and due. Since the individual mandate does not come into play until 2014, HHS is arguing it’s too soon to rule on this issue.
For the second issue, HHS is arguing three different grounds of constitutionality of the individual mandate: the Commerce Clause, the Necessary and Proper Clause, and the Tax Clause. The Supreme Court only needs to rule in favor of one of these for the mandate to be found constitutional.
For the third issue, Congress will be deciding whether the rest of the law still functions without the individual mandate, as well as whether Congress still would have enacted the rest of the law if it knew the mandate would be struck down. If the Court decides the mandate is not severable from the rest of the law, it will invalidate the entire ACA. If the Court decides the mandate is severable, the Court could strike just the mandate, or the Court could also strike the guaranteed issue and community rating provisions.
For the fourth issue, whether the Medicaid Expansion can be upheld, the states are arguing an argument based on coercion. They’re basically saying that their state budgets are so entwined in the Medicaid system that there is no way they cannot accept the Medicaid funds, therefore for HHS to say that they need to expand the mandatory groups that Medicaid will cover as well the mandatory groups that are being covered is actually coercion because HHS knows that the states are not in a position to refuse. If the Court decides the Medicaid expansion is not severable, it invalidates the entire ACA. If the Court decides the Medicaid expansion is severable, the Court could strike down just the Medicaid expansion or strike the Medicaid expansion and other provisions of the ACA.
To sum it up, here is a list of what’s at stake for health care reform in the Supreme Court:
1.) Individual Mandate
2.) Medicaid Eligibility Expansion
3.) Entire ACA, including: health insurance marking reforms, health insurance exchanges, employer responsibility provisions, tax subsidies for premiums and cost-sharing, Medicare benefits expansion, payment reductions, delivery system reforms (ACOs, etc.), Public Health and Prevention Fund, health care workforce expansions, and transparency and program integrity provisions
We’ll have additional coverage on the Supreme Court’s decision and how this could impact long-term care consumers – be on the lookout!
In addition, visit Consumer Voice’s website to view a page laying out pertinent provisions of the ACA.
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